Primary care patients did better with telemedicine than in-person visits during COVID-19 pandemic

Using telemedicine for primary care during the COVID-19 pandemic did not hurt quality of care for patients, according to a new study.

Researchers examined 16 measures of primary care quality and found patients using telemedicine had outcomes as good or better than those making in-office visits, according to the study published in JAMA Network Open. Researchers aimed to fill a gap in medical literature to understand “the relationship between the ideal blend of telemedicine and in-office care.”

“For policy makers, these findings of comparable quality support telemedicine’s continued funding,” the study said. “For practices and health systems, this study demonstrates telemedicine’s value in appropriate populations: augmenting primary care capacity without negatively affecting care quality.”

Researchers examined 526,874 patients seeking care online or in person across more than 200 outpatient sites of WellSpan Health in central Pennsylvania and northern Maryland, from March 1, 2020, to Nov. 30, 2021. The considered 16 Healthcare Effectiveness Data and Information Sets measures across five domains of primary care: cardiovascular care, diabetes, prevention and wellness, behavioral health, and pulmonary care.

Patients using telemedicine had comparably better performance in 11 of the 16 measures. Five measures indicated office-only care provided better treatment, but only three of those were statistically significant.

“Thus, for 13 of 16 measures, patients with telemedicine exposure performed comparably or better than office-only patients,” the study said. “We interpret this as telemedicine probably augmenting quality performance or, more importantly, not harming it.”

Those measures included testing-based treatments for heart disease, diabetes, and high blood pressure, and counseling-based measures such as screenings for cervical, breast, and colon cancer, tobacco counseling and intervention, depression screening, and influenza and pneumococcal vaccinations.

The three with better in-person outcomes were cardiovascular disease patients receiving antiplatelet or statin therapy, and those with antibiotic stewardship for upper respiratory infections. It is reasonable to believe those measures could be best performed in person because “starting a medication, especially a life-long medication, could be a much bigger patient-clinician decision and thus better suited in more formal, in-person discussion,” the study said.

The researchers said it was unclear why the telemedicine group performed best overall. However, for health policy about telemedicine funding, the results reinforce the need for high-value care after the COVID-19 pandemic.

“Our study is timely in addressing these quality concerns; it is no longer a hopeful question – can we deliver quality care with telemedicine? – but an evidence-supported statement: we can deliver quality care with telemedicine,” the study said.

“Comparison of Quality Performance Measures for Patients Receiving In-Person vs Telemedicine Primary Care in a Large Integrated Health System,” was published Sept. 26, 2022.